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Heart Disease and Diabetes

If you have diabetes, you are at risk for heart disease.  The American Diabetes Association recommends that you keep your ABC’s under control.  What are the ABC’s of diabetes and heart disease?  A stands for A1c (or HbA1c as it used to be known), B is for Blood Pressure, and C is for Cholesterol.  But what exactly do you have to monitor?

The A1c test

A1c is a blood test which your doctor will perform.  The A1c test measures the average blood glucose level over the three months prior to the test.  Since blood glucose levels change constantly throughout the day, this test can give you a better understanding of how well controlled your blood sugars are, and if you need to change your diabetes management strategy.  Your doctor will discuss your target goal with you, but the generally accepted target for most people is to have an A1c of under 7 percent.

While you can probably appreciate that this is an important number to know in its own right, you may not be able to logically tie it to heart disease.  It is important to know your A1c as this will tell you how well or poorly controlled your blood glucose is. This is important because the closer you can keep your blood glucose to normal, the longer you can stave off developing diabetic complications, one of the most serious of these is heart disease.

Diabetes is diagnosed as an A1c of 6.5% or higher.  People who do not have diabetes will return an A1c result of 4-6%.  Your doctor will discuss your goals with you.

Blood Pressure

You also need to keep an eye on your Blood Pressure (this is the B in the ABCs of heart disease).  Diabetics should aim to keep their blood pressure below 130/80 mmHg.  Normal blood pressure is considered to be 120/80 mmHg.  Again, your doctor will discuss your individual targets with you.

When you measure your blood pressure what you are actually monitoring is the force applied to the walls of your arteries as your heart pumps blood throughout your body.

High blood pressure is of concern because it can lead directly to coronary heart disease, heart failure, kidney failure, and stroke.  High blood pressure is also an indirect contributor to other health issues.

Cholesterol Numbers

The “C” to keep your eye on is your cholesterol levels.  Cholesterol tests usually measure four types of fats in your blood. The first of these is your overall cholesterol number. The next is your LDL cholesterol, low-density lipoprotein, is often called “bad cholesterol” causes the accumulation of plaque in your arteries.  This will reduce blood flow and can ultimately lead to either a blockage of the affected artery, or a heart attack or stroke if the plaque breaks free and causes a complete blockage of blood flow somewhere downstream.  “Good cholesterol” also known as HDL or high-density lipoprotein can help your body to remove LDL cholesterol.  Exercise can help to elevate your HDL cholesterol count.  Triglycerides are a different type of fat as well.  Your body converts unneeded calories into triglycerides which are stored in your fat cells.  Your doctor will discuss with you normal cholesterol levels and your target cholesterol numbers.

Heart Disease Statistics

Since diabetics have heart disease death rates which are two to four times higher than people without diabetes, it is very important to manage your heart disease risks.  66% of all people with diabetes die from heart disease or stroke.

While this can sound very scary, it doesn’t have to be.  The same things you need to do to have better heart health are the things you need to do to live a healthier life with diabetes.  Eat a healthy diet, exercise, stop or avoid smoking, limit alcohol consumption, and lose weight if you are overweight.

Make sure to discuss your risks and targets with your doctor.  He or she will help you devise a plan of action and will prescribe medications, where warranted, which will help you to meet your target numbers.  All of these things will help you to live a longer and healthier life.

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Heart Disease and Diabetes is from Diabetic Information & Diabetes Supplies

Dealing with Diabetes and Heart Disease

Heart disease statistics are much higher for diabetics than for the general population.  If you have type 2 diabetes, you are much more likely to have high blood pressure, high cholesterol, and other markers for heart disease.  In fact, many physicians treat people with type 2 diabetes as if they already have heart disease.

Did that give you pause?  It should have.  The fact is that diabetes contributes significantly to heart disease.  66% of diabetics are likely to die from heart disease or stroke!

Over 66% of all diabetics have high blood pressure, diagnosed as over 140/90.  Diabetes and blood pressure are major risk factors for heart disease.  Because of this, the current health recommendations state that diabetics should strive for a blood pressure level less than 130/80 mmHg.

As a diabetic, it is also important to keep an eye on your cholesterol numbers.  Your doctor will advise you what normal cholesterol levels are and what your targets should be.

Diabetes is also a major risk factor for arteriosclerosis.  (Atherosclerosis is a type of arteriosclerosis and these two terms are often used interchangeably.) Atherosclerosis occurs when cholesterol builds up on the arterial walls.  This can cause a variety of problems: the arteries can narrow; the plaque can break free and cause blockages; blood clots might form where the plaque breaks free from the arterial wall.  These things can lead to heart attack, stroke, and stroke.

According to the most 2011 National Diabetes Fact Sheet, heart disease related cause of death is two to four times as high in adults with diabetes than those without.  In adults 65 years old or older, heart disease was noted on 68% of diabetes-related death certificates, and stroke was noted on 16%.

Unfortunately, most of us who suffer from type 2 diabetes, don’t really take our disease all that seriously.  Despite all the warnings, since there is very little immediate reaction to our bad behavior it is all too easy to forego exercise or eat poorly.

The good news is that the same things you need to do to live a healthier life with diabetes will help to prevent heart disease as well.  Exercise more, eat a healthier diet, lose weight (or keep from gaining weight if you are at a good weight for your height and age), drink alcohol only moderately or not at all, and quit smoking.  These relatively easy changes in behavior will improve your blood glucose numbers and will reduce your risk of heart disease.

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Dealing with Diabetes and Heart Disease is from Diabetic Information & Diabetes Supplies

Checking for Ketones in Type 2 Diabetics

As a type 2 diabetic, you may not have heard of ketones.  However, if you have had diabetes for awhile, or if you have poor blood glucose control, it is a term you should familiarize yourself with.

What are ketones?

Ketones are created when the body breaks down fat for energy.  This can occur if you don’t consume enough carbohydrates, or if your body is not able to use blood glucose effectively.  Usually this occurs if there is not enough insulin for you to break down the sugar in your blood.

Checking for ketones

You can buy a test at your local pharmacy to check for ketones in your urine.  Ketone tests are available for purchase without a prescription.  There are two types of tests available.  You need to collect your urine and either drop a tablet into the sample, or dip a test strip into the sample.  The test strip or the sample will change color, and the color indicates a presence of ketones and the amount of ketones in your urine.

Alternately, your doctor can order a blood test to check for ketones.  There are also some home blood glucose meters which are capable of testing for ketones.  You might want this as there is a particular type of ketone which does not show up on urine tests.  Your doctor will advise you which test makes the most sense for you.

When to test of ketones in urine?

• If you are ill, you will often experience a spike in blood glucose levels.  So it can be more important to test both your blood glucose, and to test for ketones when you are ill.
• It is also important to test for ketones in your urine if you have had two or more consecutive blood glucose tests with results of 250 mg/dL.
• If you are planning on exercising at the 250 mg/dL level, you should preemptively check for ketones.  If your ketones are moderate to large, do not exercise.
• You should also check for ketones if you feel nauseous, if you are excessively thirsty or have a very dry mouth, if you feel confused, if you feel nauseous or have abdominal pain.  These symptoms may indicate high ketone levels which may require immediate treatment.

What do the test results mean?

If you have blood glucose levels deemed to be in an acceptable range (your physician will advise you what conditions and results are acceptable), and you are trying to lose weight, positive ketones shouldn’t be a problem.  However if blood glucose are high and there are positive ketones, you can experience diabetic ketoacidosis (more on that below).

You should discuss an action plan with your physician.  He or she will discuss with you what ketone levels are acceptable and when.  You can also drink plenty of water to flush out ketones. While you are doing this you should monitor your blood glucose at least every 3 hours and re-test for ketones if your blood sugar is over 250 mg/dL.

What causes ketones?

• You may have ketones in your urine in a number of circumstances.  You will burn ketones if you are on a low carb diet
• A high carb diet can also result in ketones in urine.
• Fasting for 18 hours or more can cause you to burn ketones
• Eating disorders can also cause ketones to appear in your urine.
• It is very important to be aware of your ketones if your diabetes is poorly controlled as diabetic ketoacidosis can be life threatening (more on that later).

If you have ketones in your urine, you should discuss this with your doctor.  Low levels of ketones are usually associated with fasting or low-carb diets.  High levels of ketones can indicate diabetic ketoacioses.  Again, discuss this with your doctor.  He or she will advise you as to what levels indicate a problem and what you should do in the event of a significantly high reading.  If you are dehydrated, or if you are taking certain medications or mega-doses of vitamin C, you may wind up with test results which are not meaningful.

High blood glucose readings and moderate to high ketone test results indicate that your diabetes is out of control.  You should keep a log and discuss these results with your doctor.  He or she will help you adjust your medications or your diabetes care plan in order to achieve better blood sugar control.

What is diabetic Ketoacidosis?

Diabetic ketoacidosis can result in difficulty breathing, brain swelling (also called cerebral edema), coma, or death.  As a diabetic, it is important to familiarize yourself with the symptoms of diabetic ketoacidosis, and to have a plan of action in the event of potential diabetic ketoacidosis.

Diabetic ketoacidosis symptoms include:

• Loss of appetite, abdominal pain, and vomiting.
• A strong, fruity breath odor.
• Rapid, deep breathing.
• Flushed, hot, dry skin.
• Restlessness, drowsiness or difficulty waking up. Confusion.

If you believe you are experiencing diabetic ketoacidosis, seek medical attention immediately.

The condition can be treated and involves giving the patient insulin and intravenous fluids.  Electrolytes are also closely monitored.

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Checking for Ketones in Type 2 Diabetics is from Diabetic Information & Diabetes Supplies

Warning Signs of Hypoglycemia

If you are a type 2 diabetic, or live with one, you should make sure you know the warning signs of hypoglycemia, or low blood sugar.

What is hypoglycemia?

Hypoglycemia is low blood sugar, or low blood glucose.  It occurs when blood glucose levels drop below 70 mg/dL.

Unfortunately, low blood sugar is a common occurrence in diabetics.  It is a side effect of some diabetic medications and insulin, and can occur under a wide variety of circumstances.  One of the first things you need to do as a diabetic is familiarize yourself with the symptoms of hypoglycemia.

Hypoglycemia occurs when blood sugar is lower than 70 mg/dL.  If you get this reading on your home monitor, and have no symptoms of low blood sugar, you should immediately do another test, and also check to make sure you have coded your meter correctly.  If you get a second low blood sugar reading, immediately take action.

Causes of Low Blood Sugar?

Your blood sugar levels are constantly changing throughout the day.  Glucose is the body’s main form of fuel.  As you digest food and beverages, your body converts these into fuel.  As your body uses up its fuel, your blood sugar decreases.  Hypoglycemia occurs under a variety of circumstances:

• If you skip a meal
• If you take too much medication / insulin
• If you eat too small a meal
• If you increase your physical activity
• If you consume alcoholic beverages.

Unfortunately hypoglycemia is a relatively common occurrence in people with diabetes. If you have diabetes and are taking any of the following diabetes medications, you are at risk for low blood sugar:

• acetohexamide (Dymelor)
• chlorpropamide (Diabinese)
• glimepiride (Amaryl)
• glipizide (Glucotrol, Glucotrol XL)
• glyburide (Micronase)
• mitiglinide
• nateglinide (Starlix)
• repaglinide (Prandin)
• sitagliptin (Januvia)
• tolazamide
• tolazamide (Tolinase)
• tolbutamide
• tolbutamide (Orinase)

Oral combination therapy can also cause instances of hypoglycemia, these include:

• Glipizide and metformin (Metaglip)
• glyburide and metformin (Glucovance)
• pioglitazone and glimepiride (Duetact)
• rosiglitazone and glimepiride (Avandaryl)
• sitagliptin and metformin (Janumet)

And of course, if you are taking insulin there is always the risk of a hypoglycemic event.

What to Do If You Have Low Blood Sugar?

If you think your blood sugar is too low, you should immediately check your numbers with a home blood glucose meter.  If the level is below 70 mg/dL, you should eat one of the quick-fix foods noted below.  This will immediately raise your blood glucose.  After consuming on of these foods you should check your meter to ensure the glucose levels are above 70 mg/dL.

Quick-Fix Foods for Hypoglycemia:

• 3 or 4 glucose tablets
• 1 serving of glucose gel—the amount equal to 15 grams of carbohydrate
• 1/2 cup of any fruit juice
• 1/2 cup of a regular—not diet—soft drink
• 1 cup of milk
• 5 or 6 pieces of hard candy
• 1 tablespoon of sugar or honey

If you have repeated these steps and you are still unable to get your blood sugar over 70, immediate medical attention should be sought.

If you will not be eating a meal for an hour or more after you’ve gotten your blood sugar to 70 mg/dL or higher, then you should eat a planned snack.

In the event of severe hypoglycemia, you will very likely have passed out or will be unable to treat yourself.  This is much more likely to occur in people with type 1 diabetes.  Ask your physician for a plan of action.  Usually an injection of glucagon, which can be administered by another person, will rapidly bring your blood sugar back to normal.

What are the Symptoms of Hypoglycemia?

When blood glucose levels drop too low, the body releases stress hormones.  Reaction to these hormones is an indication that you may be suffering from hypoglycemia, and you should test your blood immediately.

Warning Signs of Hypoglycemia Include:

• Cold sweats
• Convulsions
• Double vision or blurry vision
• Fast or pounding heartbeat
• General discomfort, uneasiness, or ill feeling (malaise)
• Headache
• Hunger
• Irritability (possible aggression)
• Nervousness
• Shaking or trembling
• Sleeping difficulty
• Tingling or numbness of the skin
• Tiredness or weakness
• Unclear thinking

You may not always recognize the hypoglycemia signs and / or symptoms of low blood sugar, or you may have a hypoglycemic event and not exhibit any symptoms.  If your blood sugar gets too low, you may:

• Faint
• Have a seizure
• Go into a coma

It is a good idea to wear a medical alert bracelet or necklace if you are diabetic.  Also, you should work with your physician to develop a plan in the event that you do suffer a hypoglycemic attack.  While hypoglycemia can be serious, if you can recognize low blood sugar symptoms, it can be easily managed.

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Warning Signs of Hypoglycemia is from Diabetic Information & Diabetes Supplies

Oral Medications to Lower Blood Sugar Levels

The first line of defense for most diabetics is diet and exercise. Over time however, diet and exercise alone will often not be enough to lower blood glucose levels to normal range, or acceptable levels.  Doctors will then prescribe oral medications.  There are a wide variety of oral medications on the market today.

To reduce the risk of developing diabetic complications, current recommendations suggest patients try to achieve normal blood sugar levels.  When your doctor prescribes oral diabetes medications, he or she will also suggest that you follow a diabetic diet and exercise for 30 minutes a day at least five days a week.  That’s because the medication will work better in concert with these other therapies.

Over time the effectiveness of these medications tends to decrease.  For example, it is difficult to achieve normal blood sugar levels if you have had diabetes for ten years.   When diabetes medications become less effective, it is not uncommon for your doctor to either switch you to a different medication, or prescribe a secondary oral medication.

Types of Oral Medications

There are basically six types of oral medications available to diabetics today.  These are:

• Sulfonylureas
• Biguanides
• Meglitinides
• Thiazolidinediones
• Alpha-glucosidase inhibitors
• DPP-4 inhibitors

Sulfonylureas – Sulfonylureas act in the body by increasing insulin production in the beta cells of the pancreas.  They are effective in controlling elevated blood sugar levels, and generally have a low incidence of side effects.

Sulfonylureas are not for you if you plan on getting pregnant, if you are pregnant.  They are also not good for people who have liver or kidney issues, or for people who have had serious allergic reactions to sulfa antibiotics.  The most common side effect of Sulfonylureas is low blood sugar.  This risk is exacerbated by drinking.  If you do drink, limit yourself to no more than two drinks per day, and eat something prior to drinking.

Biguanides – Biguanides work by decreasing the amount of glucose the liver produces.  They can also decrease insulin resistance and thereby allow cells to absorb blood glucose more effectively.  Metformin (a biguanide) is the most commonly prescribed drug for type 2 diabetes.  It is very well tolerated by most people and does not cause low blood sugar.  Metformin can also help to lower triglyceride levels.  It has the added benefit of helping some people to lose weight.

The most common side effects (occurring in about 5-30% of patients) are diarrhea, temporary nausea, increased gas, and a metallic taste.  Also people taking metformin may experience a decrease in B12 levels.  This usually does not cause issues, and a supplement can alleviate the issue.  There is a possible serious side effect, lactic acidosis, in which lactic acid builds up in the blood stream.  Your doctor will discuss this possibility with you.  Metformin is also widely prescribed with other drugs as a part of a “combination” therapy when one drug is not enough to bring blood sugar levels to normal ranges.

Meglitinides – Meglitinides work by increasing the amount of insulin produced by the beta cells of the pancreas.  They are prescribed for people with type 2 diabetes who have not been able to achieve normal blood sugar levels, or near normal levels with diet and exercise alone.  These drugs must be taken with meals as they can lower blood sugar if you do not eat immediately.

Side effects of meglitinides include low blood sugar, weight gain, nausea, upper respiratory infections, and joint pain.  If you have liver or kidney issues, these drugs may not be a viable option.

Thiazolidinediones – This class of drugs is also used to lower blood sugar levels.  However, troglitazone (Rezulin) was removed from the US marketplace, due to increased liver problems.  Recently this class of medication has come under increased scrutiny as liver damage may still be an associated risk.  However, the newer thiazolidinediones have not yet been shown to cause damage.  Still, thiazolidinediones are not the first choice of medications available.  Physicians may still prescribe thiazolidinediones if other medications have failed to bring blood sugar levels to normal range.

If your doctor has prescribed this class of medication, you should keep an eye out for side effects which might indicate liver damage.  These include: yellowing of the skin or the whites of the eyes, nausea, vomiting, loss of appetite, abdominal pain, dark urine, and/or fatigue.  If any of these present you should contact your physician immediately.

Alpha-glucosidase inhibitors – These drugs work by preventing the body from digesting carbohydrates and reducing the rate of sugar absorption by the intestines.  Alpha-glucosidase inhibitors are particularly helpful for people who experience high blood sugar levels after eating.  Generally, they are more effective in people whose blood glucose levels are slightly above normal.

If you are taking alpha-glucosidase inhibitors, there is a risk of low blood sugar.  Because of the way the alpha-glucosidase inhibitors work, you need to use glucose-tablets, rather than normal foods, to bring your blood sugar levels back to normal.  Side effects are usually temporary and include diarrhea, excessive gas, and abdominal discomfort.

DPP-4 Inhibitors (Dipeptidyl peptidase-4 inhibitors) – These drugs prevent the breakdown of GLP-1.  This is a compound which occurs naturally in the body and helps to reduce blood glucose levels.  DPP-4 allows GLP-1 to remain active longer and thereby reduces the production of blood sugar, only when levels are high.  It also helps the body to produce more insulin.  DPP-4 inhibitors may also help to lower cholesterol.

These drugs may not be a viable option or if you have kidney problems or are pregnant or planning to get pregnant.  Discuss these with your physician.  Side effects include diarrhea, nausea, flatulence, stuffy/runny nose, sore throat, headache, upper respiratory infection, or sensitivity to light.

When you are initially diagnosed with diabetes, your doctor is likely to prescribe an oral medication, based on your medical history.  He or she may change the medication if you are not reaching your blood sugar level goals.  After a period of time, it is likely that the oral medications will begin to lose their efficacy.  This is normal as the disease progresses.  At this point a second medication is likely to be prescribed.  This is called oral combination therapy and is effective because the drugs prescribed work differently within the body.  Because all medications have the risk of interacting with other medications and supplements you may be taking, it is important to discuss everything you take with your physician.  Don’t forget to include any over the counter items you may take.  Keep your eye out for any side effects and discuss them with your physician.  He or she will tell you if there are any urgent side effects you need to be on the lookout for.  Usually, the most common side effect is hypoglycemia.
Keeping your blood sugar levels normal for as long as possible is very important for type 2 diabetics.  Normal blood sugar levels will prevent or delay the onset of diabetic complications.  Work with your physician to determine what is a normal blood sugar level, and what your targets should be.  Taking an oral medication is one of the best ways to achieve blood sugar levels in the normal range.

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Oral Medications to Lower Blood Sugar Levels is from Diabetic Information & Diabetes Supplies

How Do You Get Diabetes?

If you watch or read the news, or if you've picked up a magazine in the past few years, you are probably aware that diabetes is becoming more and more prevalent in our society.  But short of spouting statistics at you, and telling you of the rise in incidents of childhood obesity, most of these news stories don't discuss the main concern that most people have, "How do you get diabetes?" and, "Am I at risk for getting diabetes?"

How Do You Get Diabetes?

There are a multitude of factors which come in to play in determining whether or not a person will develop diabetes. In type 1 diabetes, the pancreas does not produce enough or any insulin.  (This form of the disease is far less common than type 2 diabetes.  For all intents and purposes, when we speak of "diabetes" we are referring to type 2 diabetes, unless otherwise noted.)  The evolution of type 2 diabetes is a bit more complicated.  In addition to physiological risk factors, there are also "environmental" factors which come into play.  These include food intake and exercise. The majority of people diagnosed with type 2 diabetes are either overweight or obese.

But the blame doesn't rest solely on the individuals behavior.  If you don't have the genes which make you susceptible to getting type 2 diabetes, you won't develop the disease, no matter how overweight or sedentary you are.  Scientists are now looking to find the "diabetes genes."  Many genes are thought to be involved in the development of the disease and they may show only a slight variation in the "healthy" gene sequence.  To make matters even more complicated these variations may be extremely common. The difficulty lies in linking such common gene variations, known as single nucleotide polymorphisms (SNPs), with an increased risk of developing diabetes.

The two factors, genes and "environmental" factors,  are both important in developing the disease. First, you must inherit a predisposition to the disease. Second, something in your environment must trigger diabetes.  Genes alone are not enough to develop diabetes. Proof of this is shown by observing identical twins. Identical twins have identical genes. Yet when one twin has type 2 diabetes, the other's risk of developing the disease is at most 3 in 4.

Early Signs of Diabetes

While inherited factors are important (you cannot develop the disease if it is not in your genes to do so), environmental factors are important too!  A sedentary lifestyle and a body-mass index (BMI) over 25 are significant factors in determining who will develop type 2 diabetes.  If you have abnormal cholesterol and blood fats, such as an HDL (good) cholesterol reading lower than 35 mg/dL or a triglyceride level over 250 mg/dL, you are at an increased risk for developing diabetes. High blood pressure greater than 140 /90 in adults is also risk factor, as well as smoking.  Being 45 years of age or older and having a family history of diabetes increase your risk too.  Finally, certain ethnicities are more susceptible to developing type 2 diabetes; Hispanics, African Americans, Native Americans, and Asians have a higher than average risk.  The more risk factors you have, the more likely you are to develop the disease... So it is important to discuss your risk factors with your physician.  Being diagnosed in the early stages of the disease means that you can work to reverse it by simple lifestyle changes.  The longer you can keep your blood glucose readings close to normal, the less likely you are to develop complications.

What Else Causes Diabetes?

While family history of type 2 diabetes is one of the most important risk factors for developing the disease, it really only seems to affect those a "western" or "industrialized" lifestyle.  This is because westerners (read: Americans and Europeans) consume too much fat and too little carbohydrate and fiber, and because we get too little exercise.  In direct contrast to this are the people who live in areas of the world which have not become "westernized" -- despite genetic risk, they do not get type 2 diabetes.  But for people who have genetic risk factors, and move from an "easternized" lifestyle to a westernized one, the likelihood of developing type 2 diabetes increases dramatically.

So if you found yourself wondering, "how do you get diabetes" or "do I have diabetes," now you know that it is a combination of both genetic and lifestyle factors.  You can work with your physician to assess your risks and create a game plan.  You can take some basic steps to reduce the likelihood of developing type 2 diabetes.  Change your diet to include less fat, eat foods with a lower glycemic index, exercise more, quit smoking.  These actions will help you to live a longer, healthier life.

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What Is Pre-Diabetes

Most people who develop type 2 diabetes have lived with pre-diabetes for years before diagnosis.  So what is pre-diabetes?  Pre-diabetes is a condition in which blood glucose levels are above normal, however, they are not high enough for the patient to be diagnosed with diabetes.  Many people who are diagnosed with pre-diabetes feel this is nothing to be concerned with, after all, they are not diabetic.  However, this is a fallacy.  Pre-diabetes  can cause long-term damage to the body.  The heart and the circulatory system are especially vulnerable to damage from elevated glucose levels.

Are There Pre-Diabetes Symptoms?

So what can you do with a pre-diabetes diagnosis?  Pre-diabetes, and even diabetes itself is not a death sentence.  Many people actually find, after the initial shock and despair have worn off, that pre-diabetes can help to turn their lives around. After years of poor eating and exercise habits, pre-diabetes can often be the impetus to prompt people to adopt a healthier lifestyle.  This healthier lifestyle can also help to ward off other lifestyle diseases such as heart disease, stroke, and cancer.

Today there are over 57 million people in the United States who have pre-diabetes.  Not all of these people are aware that they have pre-diabetes.  Symptoms are often non-existent, or are easily dismissed.  They include increased thirst, more frequent urination, blurred vision, and/or a feeling of lethargy or being tired most of the time. Millions of people in the United States are walking around with pre-diabetes and have no idea they have it.   Because these symptoms can be easily misinterpreted, it is important to discuss them with your physician along with any risk factors for diabetes which you may have. Your doctor will then run basic blood tests during your next routing office visit. These risk factors include:

• being overweight
• being 45 years old or older

What Are The Risk Factors?

People who have the following risk factors (regardless of age or weight) should be tested as well:

• having high blood pressure; systolic number should be lower than 140
• having low HDL cholesterol; this number varies but the generally accepted target is over 50 mg/dl
• having high triglycerides; over 150 mg/dl
• having a family history of diabetes
• if female, having had gestational diabetes or having given birth to a baby over 9 pounds
• belonging to an ethnic or minority group at high risk for diabetes.

There are three different blood tests your doctor may choose from in order to determine whether you have diabetes or pre-diabetes:

• The first is the A1C , HbA1c, or the glycosylated hemoglobin test. It measures average blood glucose level over the last 2-3 months by measuring the amount of glucose that attaches to red blood cells.  Normal A1C is under 5.7%.  Pre-diabetes A1C  is considered between 5.7% and 6.4%.  6.5% or higher A1C signifies diabetes.
• FPG, or fasting plasma glucose test measures  the amount of blood sugar in a blood sample after an overnight fast period.  This number should read less than 100 for a normal person.  Pre-diabetes blood sugar levels measure between 101 and 125.  A reading of 126 or higher is considered diabetic.
• The OGTT, or  oral glucose tolerance test is less commonly given as it requires the patient to first take a fasting plasma glucose test. Then the patient is given a 75 gram glucose solution to ingest. Two hours later blood is drawn and blood glucose levels are measured again. Normal blood readings after the OGTT should be under 140 mg/dl. Pre-diabetes blood sugar levels are measured between 140 and 200 mg/dl. Sugar levels of 200 mg/dl or higher indicate diabetes.

If you are diagnosed with pre-diabetes, it is likely that you will develop type 2 diabetes sometime within the following 10 years, and you may already show evidence of some of the adverse health effects associated with having diabetes. It is important to take control of this condition as early as possible.  The longer you live with tight blood sugar control (keeping your blood sugar as close to normal as possible), the longer you can delay the onset of diabetes and diabetic complications.

Again, a a diagnosis of pre-diabetes is not a life sentence. Modest lifestyle changes can delay or prevent the onset of type 2 diabetes in 58% of patients studied (data source: the American Diabetes Association). Lifestyle changes including modest weight loss of 5-10%, and modest physical activity for 30 minutes daily can help to return elevated blood glucose levels close to, or even back to normal.  Increasing your physical activity, and losing weight are often the recommended first steps for heart disease, and can help to prevent cancer and stroke.  You don't even have to worry about following a pre-diabetes diet, as long as you lose weight.  Along with quitting smoking, these are some of the best things you can do for your general health, so a diagnosis of pre-diabetes, can for some people, precipitate a healthier lifestyle in general.  Take the challenge, and give yourself the gift of health!

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